Lecture 6: Nutrition and Aging

Question 1

The population is increasing and the proportion of _____ people is increasing?

Answer 1

older

life expectancy has increased drastically

Question 2

As of 2006, what is the life expectancy at birth by race and sex?

Answer 2

White female: 80.6
Black female: 76.5
White Male: 75.7
Black Male: 69.7

Question 3

By 2050 what will be the % of adults in population who are elderly in China, India, USA and Germany?

Answer 3

China: 22.6%
India: 15.1%
USA: 21.7%
Germany: 28.4%

Question 4

What are the chronic diseases of aging (lifestyle diseases)?

Answer 4

CHD
Metabolic diseases: obesity, type 2 DM
Sarcopenia
Osteoporosis
Respiratory disease
Cancer 
Cognitive decline and dementia

Question 5

Activity of what enzymes involved in xenobiotic detoxification systems decline with aging?

Answer 5

P450 content

Antipyrine Cl

Question 6

Genetics, Environment and Lifestyle factors lead to what?

Answer 6

Rate of Aging
Age related diseases and
Morbidity and mortality

Question 7

There are 4 theories of aging, each card will go through one. First is programmed aging, what is this theory?

Answer 7

Limited number of cell divisions and neuroendocrine and brain function decrease

Question 8

The second theory of aging is the inefficient DNA repair, what is this theory?

Answer 8

Over lifetime proportion of cells carrying abnormal DNA increases

Question 9

The third theory of aging is free radical damage, what is this theory?

Answer 9

Decreased efficiency of free radical scavenging systems

Question 10

The fourth theory of aging is summation of cumulative damage to life systems sustained throughout lifetime, what is this theory?

Answer 10

Accumulation of damaged cell lipids and proteins and raised levels of oxidant and inflammatory stress

Question 11

Why do we consider the elderly as a separate group?

Answer 11

• –They have special metabolic, physical, psychological and social problems not found in other age groups
• -Multiple pathologies and medications
• -Nutritional problems not recognized, undiagnosed and untreated

Question 12

What is the trend in rates of whole body protein synthesis at different stages of life?

Answer 12

Premature baby: 17.4
Infant aged 1 yr: 6.9
Young Adult: 3.0 
Elderly: 1.9 
--this decrease has an impact on maintenance of muscle mass, speed of wound healing and recovery from infection

Question 13

Aging is associated with loss of what?

Answer 13

lean body mass particularly skeletal muscle

Question 14

What are the biological, psychological and sociological nutritional supply and demands in the elderly?

Answer 14

Biology: Supply (disability) and Demand (low lean body mass, inactivity, illness)
Psychological: Supply (dementia and anorexia) and Demand (dementia)
Sociological: Supply (Access, poverty, and isolation) and Demand (institutions)

Question 15

Growth is about accumulating capacity by increasing what?

Answer 15

Form and function

Question 16

Aging is about losing capacity by decreasing what?

Answer 16

Form and function

Question 17

The functional capacity of an individual’s tissues and organs (immune system, lungs, and kidney) may _____ and _____ at different rates.

Answer 17

May develop and decline at different rates

Question 18

Lung maturity usually occurs between ages 18-25 years old, when does total dysfunction of lung occur?

Answer 18

In a healthy person: 130-140 years old

In a person who smokes and has COPD: much earlier in life

Question 19

What happens in the cardiovascular system as we age?

Answer 19

Atherosclerosis and HTN

Question 20

What happens in the central nervous system as we age?

Answer 20

Reduced cognitive function

Question 21

What happens in the musculoskeletal system as we age?

Answer 21

Skeletal muscle atrophy

Osteoporosis

Question 22

What happens to the respiratory system as we age?

Answer 22

Reduced lung volume

Obstructive pulmonary disease

Question 23

What happens in the endocrine system as we age??

Answer 23

Non-insulin dependent diabetes

Hypercortisolemia

Question 24

What happens in the immune system as we age?

Answer 24

General decline in function especially T cells

Question 25

Studies show that structural and functional decline may be related to poor nutrient intake and vitamin D status. What were the results of the lower extremity function test in these studies?

Answer 25

Performance increased as serum 25(OH)D3 increased up to ca. 40nmol/l ; beyond this improvement was less dramatic

Question 26

What is the mechanistic explanation for the lower extremity function test results found in the study?

Answer 26

1,25(OH)2D3 binds to VDRE in muscle tissue leading to protein synthesis, muscle cell growth and improved muscle function.

Question 27

with increasing age, what in the plasma increases during fasting

Answer 27

plasma Triglycerides and C reactive protein

Question 28

High levels of blood ______ and _____ double mortality risk of health non-disabled elderly

Answer 28

IL-6 | CRP

Question 29

Can the age-related decline in structure, function (and morbidity) be slowed or revered?

Answer 29

Yes: - -less smoking - -better diet - --more physical activity - --increased social interaction - -increased mental stimulation - -drugs - --other

Question 30

Increased number of health behaviors = lower risk of mortality in what types of people

Answer 30

- In men and women aged 40-79 y/o - non-smoker - not inactive - blood vit C greater than 50micromol/L (=5 fruits and veggie/day) - alcohol greater than 0 but less than 14 units/week

Question 31

What is the impact of vitamin B6, Vitamin E and selenium?

Answer 31

Improvement in immune function if deficient

Question 32

What is the impact of vitamin B6, vitamin B12 and folate?

Answer 32

Protection against lung cancer in non smokers

Question 33

What is the impact of carotenoids, vitamins C and E?

Answer 33

Adequate lifetime amounts may prevent decline in cognitive function

Question 34

What is the impact of omega 3 fatty acids?

Answer 34

Prevention or reversal of atherosclerosis, reduced inflammation, improvement in immune function

Question 35

The relationship between tooth loss and memory loss in Japanese aged 65 and above was studied, what were the results?

Answer 35

Raise inflammatory stress in aging = tooth loss and mental impairment

Question 36

What are the consequences of low food intake?

Answer 36

Increases risk of malnutrition (undernutrition) | Increased need for micronutrient dense diet

Question 37

How is frailty defined?

Answer 37

Clinical syndrome characterized by at least three of the following: - -weight loss (>5kg per year) - -self reported exhaustion - --weakness (Fall in hand grip strength) - -slow walking speed - --low physical activity

Question 38

Aging is associated with loss of lean body mass particularly ____ _____?

Answer 38

Skeletal muscle

Question 39

Excessive loss of skeletal muscle is referred to as what?

Answer 39

Sarcopenia | --18.5 billion in health care costs

Question 40

What are some consequences of sarcopenia?

Answer 40

1. Increased incidence of falls 2. Impairment in activities of daily living 3. Increased incidence in hip fractures 4. loss of strength

Question 41

What factors lead to increased morbidity and mortality in the elderly?

Answer 41

Sarcopenia Frailty Undernutrition

Question 42

What is the criteria for the diagnosis of undernutrition in the elderly?

Answer 42

``` Weight loss: >5% in 3 months >10% in 6 months BMI: less than 20kg/m2 serum albumin less than 3.5g/dl calf circumference less than 31cm (sarcopenia) ```

Question 43

What are the pro-inflammtory and anti-inflammatory cytokines?

Answer 43

IL-6,IL-1 and TNFalpha = pro-inflammatory | IL-10 = anti-inflammatory

Question 44

The influence of iL-6-174 genotype on longevity of healthy Italian men and women was measured in a study. What did the men's study show?

Answer 44

IL-6-174CC IL-6-174CG and IL-6-174GG were all measured in men and women and then divided in age groups: ---In men the healthy men it was shown that IL-6-174GG is higher from age 60-99. However past age 99, IL-6-174CG showed more of an influence on longevity

Question 45

What were the results of the IL-6-174 study for women?

Answer 45

In women it was shown that IL-6-174 GG was higher in women from age 60 until death.

Question 46

What are some practical causes of malnutrition in hospital?

Answer 46

Hospital catering (unappetizing and 1800kcal given but 50% left on the plate) - -patient nil-by-mouth or missing meals for investigations - -staff shortages and lack of help with feeding (hence cold meals, and poorly presented)

Question 47

What are some poverty based, housing based and disease/disability based factors for the elderly?

Answer 47

Poverty: 65+ year largest low income group Chronic disease or disability: 1 in 2 affected --- dementia or tooth loss. 1 in 2 women unable to cook a main meal. 1 in 10 receive meals on wheels Unfit housing: 27& 85+ year live in care

Question 48

What are some consequences of undernutrition in the elderly?

Answer 48

Increased mortality with disease or trauma Falls and bone fragility stroke, CHD, heart failure Increased susceptibility to infection/poor response to vaccination Anemia Edema or Ulcers Constipation Cognitive and self care Social functioning Poor recovery from illness or hospitalization

Question 49

What percent range of patients are admitted to the hospital undernourished?

Answer 49

15-60%

Question 50

Up to what percentage of patients discharged from the hospital weight less than on admission?

Answer 50

Up to 70%

Question 51

What are the 12 nutrition recommendations in the elderly?

Answer 51

1. Dietary reference values as basis of diets 2. Nutrient dense, varied diets 3. Moderate fat intake for health 4. Reasonable fiber intake 5. Vegetables, fruit and cereals 6. Good milk and calcium intake 7. Reduce sodium intake 8. More sunlight or use Vitamin D supplements 9. Increase health professional awareness 10. Active lifestyle 11. Improve institutional catering 12. Nutritional assessment as routine part of hospital admission

Question 52

Early recognition and intervention is essential to prevent what in the elderly?

Answer 52

Prevent undernutrition-related morbidity in the elderly.